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- Nov 13, 2004
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my apologies if this sounds at all like a lecture, but i only thought i'd post this to let you guys know of a few things that we don't and won't really think about once we start internship because it doesn't affect us directly, and we're never formally taught about it in med school. i don't know if you've ever seen an itemized hospital bill, but once i did it shocked me to learn about how much the cost of something can vary based on how the order is written in the chart, and since we'll all be writing our own orders pretty soon, i thought it might be helpful to consider a few ways that the wording of your orders can unintentionally result in hundreds of extra dollars being charged to the patient...but how are you supposed to know if no one tells you? that's why i wanted to share the following:
-we all know that ordering labs is costly and that many frown upon ordering them unnecessarily, but if you forgot to order some routine labs but still need them, just know that adding "stat" to the order will almost double the cost for this "expedited" service that the hospital is providing.
-sometimes it's tempting to just order a chem 7 or chem whatever because it saves you the time of writing out each lab you want. but sometimes all you really want to know about is the patient's Na and K or Cr...so if that's the case, just order the ones you need. otherwise it's an extra $30 +/- a few bucks for each lyte or lab value that you order but don't need or more commonly don't even look at (e.g. a routine chem 7 was $240 or so on this bill i saw). similarly, just cause Ca/Mg/Phos are often listed together, it's easy to get in the habit of ordering the three when you might only be interested in finding out one of them....so not ordering the other two could save the patient up to $100.
-as with labs, any imaging orders will be several hundred dollars more if they're ordered as "stat". a bedside CXR may be your only option for some patients, but if they're able to be transported to radiology, you'll save them quite a bit of money for doing the latter.
-if you're on autopilot and always are in the habit of ordering PT/OT to get your patients OOB, at many places one PT order will ensure that the physical therapist sees your patient not just once but for a few days. if you enter another PT order the next day, the PT will still see your patient anyway based on your prior order, but hospital billing will see that and charge the patient again for the service...and that charge can be anywhere from $300-$600.
there are some others i can list at another time, and i'm sure we could all benefit if you have something to add. either way, i think it's best if we start thinking about this now, especially since old habits are hard to break, especially when we're tired and busy. hope this helps!
-we all know that ordering labs is costly and that many frown upon ordering them unnecessarily, but if you forgot to order some routine labs but still need them, just know that adding "stat" to the order will almost double the cost for this "expedited" service that the hospital is providing.
-sometimes it's tempting to just order a chem 7 or chem whatever because it saves you the time of writing out each lab you want. but sometimes all you really want to know about is the patient's Na and K or Cr...so if that's the case, just order the ones you need. otherwise it's an extra $30 +/- a few bucks for each lyte or lab value that you order but don't need or more commonly don't even look at (e.g. a routine chem 7 was $240 or so on this bill i saw). similarly, just cause Ca/Mg/Phos are often listed together, it's easy to get in the habit of ordering the three when you might only be interested in finding out one of them....so not ordering the other two could save the patient up to $100.
-as with labs, any imaging orders will be several hundred dollars more if they're ordered as "stat". a bedside CXR may be your only option for some patients, but if they're able to be transported to radiology, you'll save them quite a bit of money for doing the latter.
-if you're on autopilot and always are in the habit of ordering PT/OT to get your patients OOB, at many places one PT order will ensure that the physical therapist sees your patient not just once but for a few days. if you enter another PT order the next day, the PT will still see your patient anyway based on your prior order, but hospital billing will see that and charge the patient again for the service...and that charge can be anywhere from $300-$600.
there are some others i can list at another time, and i'm sure we could all benefit if you have something to add. either way, i think it's best if we start thinking about this now, especially since old habits are hard to break, especially when we're tired and busy. hope this helps!
